tbuckley/cabot-search huggingface dataset:
Poliovirus antibodies following two rounds of campaigns with a type 2 novel oral poliovirus vaccine in Liberia: a clustered, population-based seroprevalence survey
Authors: Stephen B Kennedy, Grace R Macklin, Gloria Mason Ross, Rocio Lopez Cavestany, Richelot A Moukom, Kathryn A V Jones, Bernardo A Mainou, Moses B F Massaquoi, Mark W S Kieh, Ondrej Mach
Journal: The Lancet Global Health (2023)

Novel oral poliovirus vaccine type 2 (nOPV2) was administered in Liberia in response to an outbreak of circulating vaccine-derived poliovirus type 2 (cVDPV2) in 2021. We conducted a serological survey of polio antibodies after two national campaigns with nOPV2.This clustered, cross-sectional, population-based seroprevalence survey was conducted in children aged 0-59 months, more than 4 weeks after the second nOPV2 vaccination round. We used a clustered sampling method in four geographical regions of Liberia, followed by a simple random sampling of households. One eligible child was randomly selected per household. Dried blood spot specimens were taken and vaccination history was recorded. The antibody titres against all three poliovirus serotypes were assessed using standard microneutralisation assays done at the US Centers for Disease Control and Prevention in Atlanta, GA, USA.Analysable data were obtained from 436 (87%) of 500 enrolled participants. Of these, 371 (85%) children were reported via parental recall to have received two nOPV2 doses, 43 (10%) received one dose, and 22 (5%) received no doses. The seroprevalence against type 2 poliovirus was 38·3% (95% CI 33·7-43·0; 167 of 436 participants). No significant difference was observed between type 2 seroprevalence in children aged 6 months or older who were reported to have received two doses of nOPV2 (42·1%, 95% CI 36·8-47·5; 144 of 342), one dose (28·0%, 12·1-49·4; seven of 25), or no doses (37·5%, 8·5-75·5; three of eight; p=0·39). The seroprevalence against type 1 was 59·6% (54·9-64·3; 260 of 436), and the seroprevalence against type 3 was 53·0% (48·2-57·7; 231 of 436).Unexpectedly, the data showed low type 2 seroprevalence after two reported doses of nOPV2. This finding is probably affected by the lower oral poliovirus vaccine immunogenicity previously demonstrated in resource-limited settings, with high prevalence of chronic intestinal infections in children and other factors discussed herein. Our results provide the first assessment of nOPV2 performance in outbreak response in the African region.WHO and Rotary International.
Determining the efficiency path to universal health coverage: cost-effectiveness thresholds for 174 countries based on growth in life expectancy and health expenditures
Authors: Andres Pichon-Riviere, Michael Drummond, Alfredo Palacios, Sebastián Garcia-Marti, Federico Augustovski
Journal: The Lancet Global Health (2023)

Assessment of the efficiency of interventions is paramount to achieving equitable health-care systems. One key barrier to the widespread use of economic evaluations in resource allocation decisions is the absence of a widely accepted method to define cost-effectiveness thresholds to judge whether an intervention is cost-effective in a particular jurisdiction. We aimed to develop a method to estimate cost-effectiveness thresholds on the basis of health expenditures per capita and life expectancy at birth and empirically derive these thresholds for 174 countries.We developed a conceptual framework to assess how the adoption and coverage of new interventions with a given incremental cost-effectiveness ratio will affect the rate of increase of health expenditures per capita and life expectancy at the population level. The cost-effectiveness threshold can be derived so that the effect of new interventions on the evolution of life expectancy and health expenditure per capita is set within predefined goals. To provide guidance on cost-effectiveness thresholds and secular trends for 174 countries, we projected country-level health expenditure per capita and life expectancy increases by income level based on World Bank data for the period 2010-19.Cost-effectiveness thresholds per quality-adjusted life-year (QALY) ranged between US$87 (Democratic Republic of the Congo) and $95 958 (USA) and were less than 0·5 gross domestic product (GDP) per capita in 96% of low-income countries, 76% of lower-middle-income countries, 31% of upper-middle-income countries, and 26% of high-income countries. Cost-effectiveness thresholds per QALY were less than 1 GDP per capita in 168 (97%) of the 174 countries. Cost-effectiveness thresholds per life-year ranged between $78 and $80 529 and between 0·12 and 1·24 GDP per capita, and were less than 1 GDP per capita in 171 (98%) countries.This approach, based on widely available data, can provide a useful reference for countries using economic evaluations to inform resource-allocation decisions and can enrich international efforts to estimate cost-effectiveness thresholds. Our results show lower thresholds than those currently in use in many countries.Institute for Clinical Effectiveness and Health Policy (IECS).
Diagnostic yield of urine lipoarabinomannan and sputum tuberculosis tests in people living with HIV: a systematic review and meta-analysis of individual participant data
Authors: Tobias Broger, Lisa Koeppel, Helena Huerga, Poppy Miller, Ankur Gupta-Wright, François-Xavier Blanc, Aliasgar Esmail, Byron W P Reeve, Marco Floridia, Andrew D Kerkhoff, Fausto Ciccacci, Margaret P Kasaro, Swe Swe Thit, Mathieu Bastard, Gabriella Ferlazzo, Christina Yoon, Daniël J Van Hoving, Bianca Sossen, Juan Ignacio García, Matthew J Cummings, Rachel M Wake, Josh Hanson, Adithya Cattamanchi, Graeme Meintjes, Gary Maartens, Robin Wood, Grant Theron, Keertan Dheda, Ioana Diana Olaru, Claudia M Denkinger, Suzette Oelofse, Didier Laureillard, Mauro Andreotti, Obvious Nchimunya Chilyabanyama, Benjamin Welu, Lucas Molfino, Sekai Chenai Mathabire Rücker, Elisabeth Szumilin, Loide Cossa, Johanna Meléndez, Linda Mbuthini, Max O'Donnell, Joseph N Jarvis, Gcobisa Ndlangalavu, Katherine Fielding
Journal: The Lancet Global Health (2023)

Sputum is the most widely used sample to diagnose active tuberculosis, but many people living with HIV are unable to produce sputum. Urine, in contrast, is readily available. We hypothesised that sample availability influences the diagnostic yield of various tuberculosis tests.
Projecting the long-term economic benefits of reducing Shigella-attributable linear growth faltering with a potential vaccine: a modelling study
Authors: Chloe Puett, John D Anderson, Karoun H Bagamian, Farzana Muhib, Suzanne Scheele, William P Hausdorff, Clint Pecenka
Journal: The Lancet Global Health (2023)

Linear growth is an important outcome of child development with implications for economic productivity. Enteric infections, particularly Shigella, have been linked to linear growth faltering (LGF). However, benefits from potential reductions in LGF are rarely included in economic analyses of enteric infections. We aimed to quantify the economic benefits of vaccination related to reduced Shigella-attributable disease and associated LGF compared with the net costs of a vaccine programme.
Wastewater monitoring can anchor global disease surveillance systems
Authors: Aparna Keshaviah, Megan B Diamond, Matthew J Wade, Samuel V Scarpino, Warish Ahmed, Fabian Amman, Olusola Aruna, Andrei Badilla-Aguilar, Itay Bar-Or, Andreas Bergthaler, Julie E Bines, Aaron W Bivins, Alexandria B Boehm, Jean-Martin Brault, Jean-Baptiste Burnet, Joanne R Chapman, Angela Chaudhuri, Ana Maria de Roda Husman, Robert Delatolla, John J Dennehy, Megan Beth Diamond, Celeste Donato, Erwin Duizer, Abiodun Egwuenu, Oran Erster, Despo Fatta-Kassinos, Aldo Gaggero, Deirdre F Gilpin, Brent J Gilpin, Tyson E Graber, Christopher A Green, Amanda Handley, Joanne Hewitt, Rochelle H Holm, Heribert Insam, Marc C Johnson, Rabia Johnson, Davey L Jones, Timothy R Julian, Asha Jyothi, Aparna Keshaviah, Tamar Kohn, Katrin G Kuhn, Giuseppina La Rosa, Marie Lesenfants, Douglas G Manuel, Patrick M D'Aoust, Rudolf Markt, John W McGrath, Gertjan Medema, Christine L Moe, Indah Kartika Murni, Humood Naser, Colleen C Naughton, Leslie Ogorzaly, Vicka Oktaria, Christoph Ort, Popi Karaolia, Ekta H Patel, Steve Paterson, Mahbubur Rahman, Pablo Rivera-Navarro, Alex Robinson, Monica C Santa-Maria, Samuel V Scarpino, Heike Schmitt, Theodore Smith, Lauren B Stadler, Jorgen Stassijns, Alberta Stenico, Renee A Street, Elisabetta Suffredini, Zachary Susswein, Monica Trujillo, Matthew J Wade, Marlene K Wolfe, Habib Yakubu, Maria Ines Zanoli Sato
Journal: The Lancet Global Health (2023)

To inform the development of global wastewater monitoring systems, we surveyed programmes in 43 countries. Most programmes monitored predominantly urban populations. In high-income countries (HICs), composite sampling at centralised treatment plants was most common, whereas grab sampling from surface waters, open drains, and pit latrines was more typical in low-income and middle-income countries (LMICs). Almost all programmes analysed samples in-country, with an average processing time of 2·3 days in HICs and 4·5 days in LMICs. Whereas 59% of HICs regularly monitored wastewater for SARS-CoV-2 variants, only 13% of LMICs did so. Most programmes share their wastewater data internally, with partnering organisations, but not publicly. Our findings show the richness of the existing wastewater monitoring ecosystem. With additional leadership, funding, and implementation frameworks, thousands of individual wastewater initiatives can coalesce into an integrated, sustainable network for disease surveillance-one that minimises the risk of overlooking future global health threats.
Potential impact and cost-effectiveness of Shigella vaccination in 102 low-income and middle-income countries in children aged 5 years or younger: a modelling study
Authors: John D Anderson, Karoun H Bagamian, Clint J Pecenka, Farzana Muhib, Chloe A Puett, William P Hausdorff, Suzanne Scheele
Journal: The Lancet Global Health (2023)

BackgroundVaccine impact and cost-effectiveness models have mostly focused on acute burden. Shigella-attributable moderate-to-severe diarrhoea has been shown to be associated with childhood linear growth faltering. Evidence also links less severe diarrhoea to linear growth faltering. As Shigella vaccines are in late stages of clinical development, we aimed to estimate the potential impact and cost-effectiveness of vaccination against Shigella burden that includes stunting and the acute burden attributable to less severe diarrhoea and moderate-to-severe diarrhoea.MethodsWe used a simulation model to estimate Shigella burden and potential vaccination in children aged 5 years or younger from 102 low-income to middle-income countries from 2025 to 2044. Our model included stunting associated with Shigella-related moderate-to-severe diarrhoea and less severe diarrhoea and we explored vaccination impact on health and economic outcomes.FindingsWe estimate 109 million (95% uncertainty interval [UI] 39−204) Shigella-attributable stunting cases and 1·4 million (0·8–2·1) deaths in unvaccinated children over 20 years. We project that Shigella vaccination could avert 43 million (13−92) stunting cases and 590 000 (297 000–983 000) deaths over 20 years. The overall mean incremental cost-effectiveness ratio (ICER) was US$849 (95% uncertainty interval 423–1575; median $790 [IQR 635–1005]) per disability-adjusted life-year averted. Vaccination was most cost-effective in the WHO African region and in low-income countries. Including the burden of Shigella-related less severe diarrhoea improved mean ICERs by 47−48% for these groups and substantially improved ICERs for other regions.InterpretationOur model suggests that Shigella vaccination would be a cost-effective intervention, with a substantial impact in specific countries and regions. Other regions could potentially benefit upon the inclusion of the burden of Shigella-related stunting and less severe diarrhoea in the analysis.FundingBill & Melinda Gates Foundation and Wellcome Trust.
Health service quality in 2929 facilities in six low-income and middle-income countries: a positive deviance analysis
Authors: Todd P Lewis, Margaret McConnell, Amit Aryal, Grace Irimu, Suresh Mehata, Mwifadhi Mrisho, Margaret E Kruk
Journal: The Lancet Global Health (2023)

BackgroundPrimary care is of insufficient quality in many low-income and middle-income countries. Some health facilities perform better than others despite operating in similar contexts, although the factors that characterise best performance are not well known. Existing best-performance analyses are concentrated in high-income countries and focus on hospitals. We used the positive deviance approach to identify the factors that differentiate best from worst primary care performance among health facilities across six low-resource health systems.MethodsThis positive deviance analysis used nationally representative samples of public and private health facilities from Service Provision Assessments of the Democratic Republic of the Congo, Haiti, Malawi, Nepal, Senegal, and Tanzania. Data were collected starting June 11, 2013, in Malawi and ending Feb 28, 2020, in Senegal. We assessed facility performance through completion of the Good Medical Practice Index (GMPI) of essential clinical actions (eg, taking a thorough history, conducting an adequate physical examination) according to clinical guidelines and measured with direct observations of care. We identified hospitals and clinics in the top decile of performance (defined as best performers) and conducted a quantitative, cross-national positive deviance analysis to compare them with facilities performing below the median (defined as worst performers) and identify facility-level factors that explain the gap between best and worst performance.FindingsWe identified 132 best-performing and 664 worst-performing hospitals, and 355 best-performing and 1778 worst-performing clinics based on clinical performance across countries. The mean GMPI score was 0·81 (SD 0·07) for the best-performing hospitals and 0·44 (0·09) for the worst-performing hospitals. Among clinics, mean GMPI scores were 0·75 (0·07) for the best performers and 0·34 (0·10) for the worst performers. High-quality governance, management, and community engagement were associated with best performance compared with worst performance. Private facilities out-performed government-owned hospitals and clinics.InterpretationOur findings suggest that best-performing health facilities are characterised by good management and leaders who can engage staff and community members. Governments should look to best performers to identify scalable practices and conditions for success that can improve primary care quality overall and decrease quality gaps between health facilities.FundingBill & Melinda Gates Foundation.
A biocompatible gelatin sponge scaffold confers robust tissue remodeling after spinal cord injury in a non-human primate model
Authors: Xiang Zeng, Qing-shuai Wei, Ji-chao Ye, Jun-hua Rao, Mei-guang Zheng, Yuan-huan Ma, Li-zhi Peng, Ying Ding, Bi-qin Lai, Ge Li, Shi-xiang Cheng, Eng-Ang Ling, Inbo Han, Yuan-shan Zeng
Journal: Biomaterials (2023)
Social Deprivation and the Risk of Screening Positive for Glaucoma in the MI-SIGHT Telemedicine-Based Glaucoma Detection Program
Authors: Paula Anne Newman-Casey, Joah Aliancy, Ming-Chen Lu, Maria A. Woodward, Patrice M. Hicks, Leslie M. Niziol, David C. Musch, Amanda K. Bicket, Denise John, Olivia Killeen, Sarah D. Wood, Leroy Johnson, Martha Kershaw, Jason Zhang, Angela R. Elam
Journal: Ophthalmology (2023)
Nonalcoholic Fatty Liver Disease and Omega-3 Fatty Acids: Mechanisms and Clinical Use
Authors: Melinda H. Spooner, Donald B. Jump
Journal: Annual Review of Nutrition (2023)

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic fatty liver disease worldwide, particularly in obese and type 2 diabetic individuals. Currently, there are no therapies for NAFLD that have been approved by the US Food and Drug Administration. Herein, we examine the rationale for using ω3 polyunsaturated fatty acids (PUFAs) in NAFLD therapy. This focus is based on the finding that NAFLD severity is associated with a reduction of hepatic C20-22 ω3 PUFAs. Because C20-22 ω3 PUFAs are pleiotropic regulators of cell function, loss of C20-22 ω3 PUFAs has the potential to significantly impact hepatic function. We describe NAFLD prevalence and pathophysiology as well as current NAFLD therapies. We also present evidence from clinical and preclinical studies that evaluated the capacity of C20-22 ω3 PUFAs to treat NAFLD. Given the clinical and preclinical evidence, dietary C20-22 ω3 PUFA supplementation has the potential to decrease human NAFLD severity by reducing hepatosteatosis and liver injury.
Through-the-scope suture closure of nonampullary duodenal endoscopic mucosal resection defects: a retrospective multicenter cohort study
Authors: Jose Antonio Almario, Linda Y. Zhang, Jonathan Cohen, Gregory B. Haber, Hemchand Ramberan, Andrew C. Storm, Stuart Gordon, Jeffrey M. Adler, Heiko Pohl, Alexander Schlachterman, Anand Kumar, Shailendra Singh, Bashar Qumseya, Peter V. Draganov, Nikhil A. Kumta, Andrew Canakis, Raymond Kim, Hiroyuki Aihara, Apurva Shrigiriwar, Saowanee Ngamruengphong, Mouen A. Khashab
Journal: Endoscopy (2023)

Background Delayed bleeding is among the most common adverse events associated with endoscopic mucosal resection (EMR) of nonampullary duodenal polyps. We evaluated the rate of delayed bleeding and complete defect closure using a novel through-the-scope (TTS) suturing system for the closure of duodenal EMR defects. Methods We reviewed the electronic medical records of patients who underwent EMR for nonampullary duodenal polyps of ≥ 10 mm and prophylactic defect closure with TTS suturing between March 2021 and May 2022 at centers in the USA. We evaluated the rates of delayed bleeding and complete defect closure. Results 36 nonconsecutive patients (61 % women; mean [SD] age, 65 [12] years) underwent EMR of ≥ 10-mm duodenal polyps followed by attempted defect closure with TTS suturing. The mean (SD) lesion size was 29 (19) mm, defect size was 37 (25) mm; eight polyps (22 %) involved &gt; 50 % of the lumen circumference. Complete closure was achieved in all cases (78 % with TTS suturing alone), using a median of one TTS suturing kit. There were no cases of delayed bleeding and no adverse events attributed to application of the TTS suturing device. Conclusion Prophylactic closure of nonampullary duodenal EMR defects using TTS suturing resulted in a high rate of complete closure and no delayed bleeding events.
Current and Future Advances in Surgical Therapy for Pituitary Adenoma
Authors: Danyal Z Khan, John G Hanrahan, Stephanie E Baldeweg, Neil L Dorward, Danail Stoyanov, Hani J Marcus
Journal: Endocrine Reviews (2023)

The vital physiological role of the pituitary gland, alongside its proximity to critical neurovascular structures, means that pituitary adenomas can cause significant morbidity or mortality. While enormous advancements have been made in the surgical care of pituitary adenomas, numerous challenges remain, such as treatment failure and recurrence. To meet these clinical challenges, there has been an enormous expansion of novel medical technologies (eg, endoscopy, advanced imaging, artificial intelligence). These innovations have the potential to benefit each step of the patient's journey, and ultimately, drive improved outcomes. Earlier and more accurate diagnosis addresses this in part. Analysis of novel patient data sets, such as automated facial analysis or natural language processing of medical records holds potential in achieving an earlier diagnosis. After diagnosis, treatment decision-making and planning will benefit from radiomics and multimodal machine learning models. Surgical safety and effectiveness will be transformed by smart simulation methods for trainees. Next-generation imaging techniques and augmented reality will enhance surgical planning and intraoperative navigation. Similarly, surgical abilities will be augmented by the future operative armamentarium, including advanced optical devices, smart instruments, and surgical robotics. Intraoperative support to surgical team members will benefit from a data science approach, utilizing machine learning analysis of operative videos to improve patient safety and orientate team members to a common workflow. Postoperatively, neural networks leveraging multimodal datasets will allow early detection of individuals at risk of complications and assist in the prediction of treatment failure, thus supporting patient-specific discharge and monitoring protocols. While these advancements in pituitary surgery hold promise to enhance the quality of care, clinicians must be the gatekeepers of the translation of such technologies, ensuring systematic assessment of risk and benefit prior to clinical implementation. In doing so, the synergy between these innovations can be leveraged to drive improved outcomes for patients of the future.
When I use a word . . . Medical definitions: Goldfinger events
Authors: Jeffrey K Aronson
Journal: BMJ (2023)

There are three types of anecdotal reports of adverse events that are suspected adverse drug reactions and can give rise to pharmacovigilance signals. First, between-the-eyes anecdotes, a single one of which provides strong evidence of a causative association; secondly, data mining anecdotes, each of which on its own is of little evidential value but which taken together can provide a signal, and thirdly anecdotes about designated medical events, three or more of which collectively provide strong evidence. I prefer to call the last of this category “Goldfinger events,” quoting the eponymous villain in Ian Fleming’s 1959 novel: “Once is happenstance. Twice is coincidence. The third time it’s enemy action.”
Malnourished Microbes: Host–Microbiome Interactions in Child Undernutrition
Authors: Helen J. Jones, Claire D. Bourke, Jonathan R. Swann, Ruairi C. Robertson
Journal: Annual Review of Nutrition (2023)

Childhood undernutrition is a major global health burden that is only partially resolved by nutritional interventions. Both chronic and acute forms of child undernutrition are characterized by derangements in multiple biological systems including metabolism, immunity, and endocrine systems. A growing body of evidence supports a role of the gut microbiome in mediating these pathways influencing early life growth. Observational studies report alterations in the gut microbiome of undernourished children, while preclinical studies suggest that this can trigger intestinal enteropathy, alter host metabolism, and disrupt immune-mediated resistance against enteropathogens, each of which contribute to poor early life growth. Here, we compile evidence from preclinical and clinical studies and describe the emerging pathophysiological pathways by which the early life gut microbiome influences host metabolism, immunity, intestinal function, endocrine regulation, and other pathways contributing to child undernutrition. We discuss emerging microbiome-directed therapies and consider future research directions to identify and target microbiome-sensitive pathways in child undernutrition.